Surgery for secondary hyperparathyroidism

Secondary hyperparathyroidism is a systemic metabolic derangement that leads to massive expansion of parathyroid tissue and overproduction of parathyroid hormone. Accurate biochemical diagnosis is crucial to establishing a plan of care for these patients. Indications and timing of surgical intervention once refractory to medical management are best established through multidisciplinary care including an expert parathyroid surgeon. Principles of careful parathyroid surgery including identification of all parathyroid tissue in a bloodless field allow for the appropriate management of parathyroid excision. Subtotal resection of parathyroid tissue and total parathyroidectomy with immediate parathyroid autotransplantation are equivalent options. Hypocalcemia is the most common postoperative occurrence and should be anticipated and managed aggressively.